Caesarean sections (C-section) have been around for a long time but have become more prevalent in recent years with 1 in 3 women undergoing a C-section according to the International Cesarean Awareness Network (ICAN). Unfortunately, it is common for women to have persistent pain, numbness, and burning after their C-section, not to mention poor core strength and neuromuscular control, ie: the ability to correctly activate those muscles.
While the specific surgical technique can vary for C-sections, the most common method involves a horizontal incision slightly above the pubic bone, then the separation of the muscles in order to get to the uterus. Surgical techniques and protocols are not my area of expertise so I can only give you a general overview but it is important to understand the trauma that the body goes through during a C-section. In some techniques, the muscles are cut, but the most common technique pulls the muscle layers apart which places a great deal of stretch on the muscles, connective tissue, and nerves.
Underneath the skin lies a layer of connective tissue, called fascia, which also surrounds all of the nerves and blood vessels. Deep to that lay your muscles with a layer of fascia surrounding each muscle so they can glide over one another when overlapping. With a C-section, the muscles and fascia get pulled apart far enough to pull your baby out. As part of healing, those muscles have to try to go back to their original place (in addition to being stretched from being pregnant) and the fascia has to realign itself. The skin also must heal up from the incision and it is a natural part of the healing process for your body to produce scar tissue. Scar tissue is highly variable but can create adhesions between the tissues underneath the skin.
These adhesions limit how the tissues glide over one another so they essentially get “stuck” on each other. This can create problems because the limitations don’t allow the tissues to work how they are supposed to. The fascial layer also gets stretched and disrupted, which pulls on all of the nerves that are within that layer. As things heal up, the fascia often does not go back to how it was prior to C-section. Together, the bound up fascial layer and adhesions/scar tissue create a lot of the common complaints after C-section such as numbness, burning, pain, or electric shock sensations.
While most things you may have read talk about nerve damage during C-sections, a lot of these symptoms actually are symptoms of scar tissue and disruption of the fascial layer. When the fascia gets damaged, it often gives burning sensations or like a hot knife is going through that area. Scar tissue can create pain and/or numbness in an area. The nerves can be overstretched along with the fascia and contribute to some of the sensations but they typically respond well to desensitization techniques. There are instances where the nerves can be severed but it is highly likely that all of your symptoms do not stem solely from nerve damage.
In addition to all of the weird sensations and pain that can occur after a C-section, the core muscles are also greatly affected. For starters, they get pulled apart and stretched to their max after being stretched out for 9 months prior to that. This makes them not work very efficiently. Every muscle has an optimal length to produce a contraction. When the four layers of core muscles are stretched to a longer length, they aren’t able to contract as strongly. The stretching also disrupts the nerve innervation to these muscles so your muscles aren’t getting the correct signals from the brain when you are trying to contract them. And with the fascial layer being bound up and not aligned properly, it makes it more difficult for the muscles to contract properly. All of these issues are common for anyone after pregnancy but there is more damage after a C-section. Without core muscles that work properly, your trunk will not have the stability and support that it truly needs. This is a main contributor to low back pain especially since you will now be lifting and holding a baby which puts a higher demand for the need for stability and support.
Most women are not aware of the traumas that occur during pregnancy and particularly with C-sections. Due to this, most of these issues never get addressed and women end up living with pain for many years because they never knew what to do for it. All of these issues can be resolved with proper physical therapy treatment that utilizes hands-on techniques to break up the scar tissue, realign the fascia, normalize sensation, and retrain the muscles. If you are in the Milwaukee area and have had a C-section, give me a call at (414) 331-2323 or email me at Brenda@Revitalize-PT.com. I also want to mention that these issues can last for years and years. I have seen women with these issues from a C-section that occurred 15 years ago. So the takeaway is that it’s never too late to seek out treatment and that these issues don’t tend to spontaneously resolve. Check out our website for more information and feel free to reach out to me with any questions.